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CHF and CAD
Cardiac glycosides and antianginal
| Question | Answer |
|---|---|
| Chest pain due to coronary artery disease (CAD) and myocardial ischemia | Angina Pectoris |
| Chest pain, insufficient blood flow to the heart, caused by arthrosclerosis, spasm | angina pectoris |
| Cause, risk factor, patient education for Angina pectoris | Very high risk for MI, Life style change, avoid high cholesterol, exercise |
| What cause CAD? | arthrosclerosis, plaque build up in the blood vessels |
| Main symptom of CAD? | Angina pectoris, chest pain |
| Pharm tx and teaching for angina pectoris (CAD, Coronary Artery Disease) | Mainly Nitroglycerine, Med (nitrate), if tablet, out of direct sun light, chock under the tongue to be felt, check blood pressure because it’s gonna lower, on a sitting position |
| Acute angina tx vs chronic angina tx different med/delivery | Nitro SL for acute, transdermal patch or paste for chronic. Works for 30 to 35 min, not touch, BP before giving again |
| How is transdermal, nitro paste, nitro SL are different/same | SL for acute, paste and transdermal for chronic, remove the old one before putting the new one (alternate side) |
| What are common side/adverse effect of nitro and calcium antagonists? | Vasodilation, Headache (HA), decrease Heart rate, tachycardia, dizziness, constipation, nausea |
| Drugs Used to Treat CAD | Nitrites and nitrates, Beta adrenergic blocking drugs, Calcium antagonists |
| Mechanism of Nitrites and Nitrates? | Dilate blood vessel, blood flow increased, BP decreases |
| How many times can a Nitrate given? | Up to 3 times, take BP in between, because it will decrease. |
| Why Beta blockers for CAD? | Beta blocker create less work force on the heart |
| How do Beta Adrenergic Blockers works in relation with CAD? | Sympathetic beta receptor stimulation of the heart increases heart rate, increases force of contraction, and increases oxygen consumption, Blockade of beta receptors decreases cardiac work and cardiac oxygen demand |
| Verapamil | Calcium antagonist, works on heart |
| What are the common Ca+ channel blockers? Effects on heart 1 heart rate 2 force of contraction? | Verapamil (on Heart and blood vessels), Nifedepine (only blood vessel), Diziltiazem (on Heart and blood vessels) |
| What is CHF? What happens? | Weakening of the contractile function of the heart, blood and fluid accumulate in the heart, lungs, abdomen, and lower extremities, decreased cardiac output and blood pressure are unable to meet body requirements |
| How is CHF related to fluid excretion? | If the heart doesn’t pump effectively, the kidney will not receive blood and will secrete renin, then angiotensin to compensate and create vasoconstriction which is bad again for the blood flow that was already low. |
| How are cardiac glycosides able to improve symptoms of CHF? | Increase the force of contraction of myocardium and decrease the heart rate. |
| Cardiac glycosides effects on heart rate, effect on force of heart contraction, contraindications | Increase the force of contraction and decrease the heart rate, contraindicated if HR at least 60 |
| Where do Cardiac glycosides come from | Plants |
| Compare and contrast Digoxin and Digitoxin | Digoxin is water soluble and eliminated mostly unmetabolized by the urinary tract, less likely to be toxic, Digitoxin has to be metabolized, lipid (fat) soluble, long life. It’s more toxic |
| What impact can K+ levels have on therapeutic action of a cardiac glycoside? | Low Potassium will increase drug toxicity can lead to cardiac arrhythmias; High Potassium will decrease the action of the cardiac glycosides (the drug will not work) |
| What to check before giving a cardiac glycoside? | Pulse below 60, serum blood level at 0.5-2mg/mL Potassium not too high and not too low. |
| Describe common causes and symptoms of CHF | weakening of contractility of heart muscles. Coughing, SOB, confusion, Anxiety, Edema, Fatigue, |
| Cardiac glycoside treat CHF and | Atria arrhythmias and atria fibulation |
| Why diuretic treat CHF? | If a patient has CHF, he has extra fluid in the body, he need diuretic to eliminate those extra fluid. |
| Review diuretic concerns (CHF, K+ levels, cardiac glycoside) Impact on K | A diuretic has an impact on potassium level (the kidney is not functioning well, K+ stays in the body), it’s also going to decrease the action of the cardiac glycoside. Avoid K rich food, avoid fruits. |
| How does ACE inhibitors work with CHF? | By causing vasodilation, less work on the heart, blood flowing more easily. They help the heart by working on the blood vessel. |
| PVC | Premature ventricular contractions, very common, problem when 4/min |
| Ectopic beat | Irregular heart beat |
| Afib | Less serious than Vfib |
| Heparin and warfarin | Heparin by injection, Warfarin/Coumarin PO |
| Which blood vessels will vasodilators work (have effect) on ? What will they do to cardiac O2 consumption? | Both arteries and Veins. Cardiac will be less, cuz less pressure so less need O2 |
| Main Diseases of the Heart | Congestive heart failure (CHF), Coronary artery disease (CAD), Myocardial infarction (MI), Cardiac arrhythmias |
| Why edema in Pregnant women? | Because double pump for baby, and the heart is squeezed in the cage, not pumping effectively |
| What does QRS complex shows? | Contraction of ventricle |
| Swelling in the abdomen, fluid build up | Ascites |
| Begins electrophysiology in the heart | SA Node |
| Review parts of electrical conduction system of heart Begin with SA Node, every level has his level of electricity | SA and AV node, bundle of His, bundle branches, and Purkinje fibers |
Created by:
fausfez
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